Can C-Reactive Protein and Fibrinogen Predict Major Adverse Cardiac Events in Cardiovascular and Cerebrovascular Patients?

Abstract

Background:We aimed to examine the value ofC-reactive protein (CRP)and fibrinogen levels to predictcardiovascular events and compare theirpredicting power between patients witha history of the acute coronary syndrome, patients with a history of stroke (ischemic type),and healthy individuals.Methods:Thiscase-control study assessed79 patients with ahistory ofthe acute coronary syndromeand 88 patients with a history of stroke (cerebral ischemia) occurring at least3 months previously. The patients were selected and followed up from September 2013 to September 2014 for 3 and 6 months after initial assessment to determine 6-month major adverse cardiac events(MACE). The serum levels of CRP and fibrinogen were measured using ELISA kits. Results:The serum CRP level was significantly higher in the group with the acute coronary syndrome than in the group with a history of stroke andinthe healthy group (P=0.045). The Cox regression model showedincreasedlevelsof CRP (HR=1.29 [1.01-1.66];P=0.038) and fibrinogen (HR=1.01 [1.01-1.02]; P<0.001)in the group with ahistory ofthe acute coronary syndrome. It also demonstrated increased levelsof CRP(HR=1.61 [0.97-2.67]; P=0.065) and fibrinogen (HR=1.02 [1.01-1.04];P=0.010)in the stroke groupand increased levels of CRP(HR= 2.06 [0.71-5.99]; P=0.183) and fibrinogen (HR=1.01 [0.99-1.04]; P=0.294)in the normal group. Consequently,the groupswith ahistoryof theacute coronary syndrome anda history ofstroke effectively predicted6-month MACE in the crude and age-and sex-adjusted models. Conclusions:Our study achieved 2 important findings. First, our resultsshowedthathigher values of these biomarkers were able to predict MACE, even aftertheinclusionof baseline covariates. Increased levelsof CRP and fibrinogen,measured after evaluating the acute phase and their related outcome, were able to predict recurrent cardiovascular eventsin the patients with a history of cerebrovascular ischemia andtheacute coronary syndrome.In addition,there were higherlevels of both CRP and fibrinogen markers in thepatients with ahistory oftheacute coronary syndrome and stroke than in the healthy individuals. (Iranian Heart Journal 2015; 16(4): 19-27)